CoChat
Sign Up
Cited by 82Cardiovascular and exercise physiologyHeart Failure Treatment and ManagementCardiac Health and Mental Health

Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation

Open access
Luo, Nancy, Merrill, Peter, Parikh, Kishan S., Whellan, David J., Piña, Ileana L., Fiuzat, Mona, Kraus, William E., Kitzman, Dalane W. +3 more·2017·Journal of the American College of Cardiology
DOI 10.1016/j.jacc.2017.01.032PMC PMC5380238
Open this paper in CoChat — free accountOpen PDF

Abstract

Background The safety and efficacy of aerobic exercise in heart failure (HF) patients with atrial fibrillation (AF) has not been well evaluated. Objectives This study examined whether outcomes with exercise training in HF vary according to AF status. Methods HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) randomized 2,331 ambulatory HF patients with ejection fraction ≤35% to exercise training or usual care. We examined clinical characteristics and outcomes (mortality/hospitalization) by baseline AF status (past history of AF or AF on baseline electrocardiogram vs. no AF) using adjusted Cox models and explored an interaction with exercise training. We assessed post-randomization AF events diagnosed via hospitalizations for AF and reports of serious arrhythmia caused by AF. Results Of 2,292 patients with baseline rhythm data, 382 (17%) had AF, 1,602 (70%) had sinus rhythm, and 308 (13%) had "other" rhythm. Patients with AF were older and had lower peak Vo 2. Over a median follow-up of 2.6 years, AF was associated with a 24% per year higher rate of mortality/hospitalization (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.34 to 1.74; p < 0.001) in unadjusted analysis; this did not remain significant after adjustment (HR: 1.15; 95% CI: 0.98 to 1.35; p = 0.09). There was no significant difference in AF event rates by randomized treatment assignment in the overall population or by baseline AF status (all p > 0.10). There was no interaction between AF and exercise training on measures of functional status or clinical outcomes (all p > 0.10). Conclusions AF in patients with chronic HF was associated with older age, reduced exercise capacity at baseline, and a higher overall rate of clinical events, but not a differential response to exercise training for clinical outcomes or changes in exercise capacity. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437).

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1016/j.jacc.2017.01.032

Cites

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • In the HF-ACTION study, 193 individuals with AF and heart failure underwent 36 sessions of supervised exercise followed by a 2-year home-based rehabilitation program, and investigators did not observe any difference in hospitalizations, mortality, events related to AF, or other major outcomes between the training and control group after a median follow-up of 2.6 years.

    “In the HF-ACTION study, 193 individuals with AF and heart failure (HF) initially underwent 36 sessions of supervised exercise, and then continued a 2-year home-based rehabilitation program [72]. Investigators did not observe any difference in the number of hospitalizations, mortality, events related to AF, or other major outcomes between the training and the control group after a median follow-up”

    From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [72]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

The citation lists haven’t been fetched yet

References 31 · Cited by 82

Research works printed but not linked: 25

  1. [1]Mozaffarian D Benjamin EJ Go AS Heart disease and stroke statistics--2015 update: a report from the American Heart Association Circulation 2015 131 e29 322 25520374
  2. [2]Santhanakrishnan R Wang N Larson MG Atrial fibrillation begets heart failure and vice versa: temporal associations and differences in preserved versus reduced ejection fraction Circulation 2016 133 484 92 26746177 PMC4738087
  3. [4]Malmo V Nes BM Amundsen BH Aerobic interval training reduces the burden of atrial fibrillation in the short term: a randomized trial Circulation 2016 133 466 73 26733609
  4. [5]Faselis C Kokkinos P Tsimploulis A Exercise capacity and atrial fibrillation risk in veterans: a cohort study Mayo Clin Proc 2016 91 558 66 27068670
  5. [6]Kapa S Asirvatham SJ A MET a day keeps arrhythmia at bay: the association between exercise or cardiorespiratory fitness and atrial fibrillation Mayo Clin Proc 2016 91 545 50 27068668
  6. [7]O’Connor CM Whellan DJ Lee KL Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial JAMA 2009 301 1439 50 19351941 PMC2916661
  7. [8]Flynn KE Pina IL Whellan DJ Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial JAMA 2009 301 1451 9 19351942 PMC2690699
  8. [9]Whellan DJ O’Connor CM Lee KL Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): design and rationale Am Heart J 2007 153 201 11 17239677
  9. [10]Green CP Porter CB Bresnahan DR Spertus JA Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure J Am Coll Cardiol 2000 35 1245 55 10758967
  10. [11]Spertus J Peterson E Conard MW Monitoring clinical changes in patients with heart failure: a comparison of methods Am Heart J 2005 150 707 15 16209970
  11. [12]Keteyian SJ Leifer ES Houston-Miller N Relation between volume of exercise and clinical outcomes in patients with heart failure J Am Coll Cardiol 2012 60 1899 905 23062530 PMC3804919
  12. [13]O’Connor CM Mentz RJ Whellan DJ Covariate adjustment in heart failure randomized controlled clinical trials: a case analysis of the HF-ACTION trial Heart Fail Clin 2011 7 497 500 21925432
  13. [14]O’Connor CM Whellan DJ Wojdyla D Factors related to morbidity and mortality in patients with chronic heart failure with systolic dysfunction: the HF-ACTION predictive risk score model Circ Heart Fail 2012 5 63 71 22114101 PMC3692371
  14. [16]Dries DL Exner DV Gersh BJ Domanski MJ Waclawiw MA Stevenson LW Atrial fibrillation is associated with an increased risk for mortality and heart failure progression in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a retrospective analysis of the SOLVD trials. Studies of Left Ventricular Dysfunction J Am Coll Cardiol 1998 32 695 703 9741514
  15. [17]Pardaens K Van Cleemput J Vanhaecke J Fagard RH Atrial fibrillation is associated with a lower exercise capacity in male chronic heart failure patients Heart 1997 78 564 8 9470871 PMC1892336
  16. [18]DeFina LF Haskell WL Willis BL Physical activity versus cardiorespiratory fitness: two (partly) distinct components of cardiovascular health? Prog Cardiovasc Dis 2015 57 324 9 25269066
  17. [19]Myers J McAuley P Lavie CJ Despres JP Arena R Kokkinos P Physical activity and cardiorespiratory fitness as major markers of cardiovascular risk: their independent and interwoven importance to health status Prog Cardiovasc Dis 2015 57 306 14 25269064
  18. [20]Osbak PS Mourier M Kjaer A Henriksen JH Kofoed KF Jensen GB A randomized study of the effects of exercise training on patients with atrial fibrillation Am Heart J 2011 162 1080 7 22137082
  19. [21]Hegbom F Stavem K Sire S Heldal M Orning OM Gjesdal K Effects of short-term exercise training on symptoms and quality of life in patients with chronic atrial fibrillation Int J Cardiol 2007 116 86 92 16815571
  20. [23]Morseth B Graff-Iversen S Jacobsen BK Physical activity, resting heart rate, and atrial fibrillation: the Tromso Study Eur Heart J 2016 37 2307 13 26966149 PMC4986028
  21. [24]Yancy CW Jessup M Bozkurt B 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J Am Coll Cardiol 2013 62 e147 239 23747642
  22. [25]Thompson PD Franklin BA Balady GJ Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology Circulation 2007 115 2358 68 17468391
  23. [26]Piccini JP Hellkamp AS Whellan DJ Exercise training and implantable cardioverter-defibrillator shocks in patients with heart failure: results from HF-ACTION (Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing) JACC Heart Fail 2013 1 142 8 23936756 PMC3735226
  24. [27]Plisiene J Blumberg A Haager G Moderate physical exercise: a simplified approach for ventricular rate control in older patients with atrial fibrillation Clin Res Cardiol 2008 97 820 6 18648726
  25. [28]McManus DD Hsu G Sung SH Atrial fibrillation and outcomes in heart failure with preserved versus reduced left ventricular ejection fraction J Am Heart Assoc 2013 2 e005694 23525446 PMC3603249

Authors
Luo, N., Merrill, P., Parikh, K. S., Whellan, D. J., Piña, I. L., Fiuzat, M., Kraus, W. E., Kitzman, D. W., Keteyian, S. J., O’Connor, C. M., & Mentz, R. J.
Affiliations
  • Duke University (US)
  • Thomas Jefferson University (US)
  • Albert Einstein College of Medicine (US)
  • Duke Medical Center (US)
  • Wake Forest University Health Sciences (US)
  • Henry Ford Hospital (US)
  • Inova Health System (US)
Corresponding author
Luo, Nancy
ORCID
Venue
Journal of the American College of Cardiology
Publisher
Elsevier BV
Published
2017-04
Volume
69
Issue
13
Pages
1683-1691
ISSN
0735-1097 (ISSN-L)
DOI
10.1016/j.jacc.2017.01.032
PMC
PMC5380238
OpenAlex
W2598749102
Cited by
82
References
31
Citations by year
2026: 4 · 2025: 8 · 2024: 20 · 2023: 8 · 2022: 8 · 2021: 6 · 2020: 11 · 2019: 4 · 2018: 7 · 2017: 6
FWCI
11.35
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American College of Cardiology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Amgen (R01AG045551-01A1, U10HL110312)
  • Bristol-Myers Squibb
  • AstraZeneca
  • GlaxoSmithKline
  • Gilead Sciences
  • Thoratec Corporation
  • HeartWare
  • Luitpold Pharmaceuticals
  • ResMed (R01AG045551-01A1)
  • National Institutes of Health
  • National Institute on Aging (R01AG045551, P30AG021332)
  • National Heart, Lung, and Blood Institute (U10HL110312)
Topics
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
chronic heart failure, atrial fibrillation, aerobic exercise training, exercise capacity, mortality, hospitalization, cardiac arrhythmias, HF-ACTION trial, ejection fraction, functional status
MeSH terms
Aged, Atrial Fibrillation, Female, Heart Failure, Humans, Male, Middle Aged, United States, Exercise, Exercise Tolerance

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review